Sleep disturbances in anxiety disorders: State of the art and management

Anxiety disorders are the most prevalent psychiatric conditions globally, affecting up to one in four individuals over a lifetime. A strong and bidirectional relationship exists between anxiety and sleep disturbances: anxiety profoundly disrupts sleep, while poor sleep exacerbates psychological vulnerability, thereby exacerbating anxiety. This review provides a detailed exploration of how different anxiety disorders impact sleep and emphasizes the clinical importance of addressing both dimensions concurrently. This review demonstrates that sleep disturbances in anxiety disorders manifest heterogeneously, impacting sleep onset, maintenance, and depth. In generalized anxiety disorder (GAD), over 80% of patients suffer from insomnia, characterized by prolonged sleep latency, frequent awakenings, and non-restorative sleep. Panic disorder often involves nocturnal panic attacks that create anticipatory anxiety around sleep itself. PTSD is strongly linked to recurrent nightmares and hyperarousal, with significant polysomnographic evidence of disrupted sleep architecture. Obsessive-compulsive disorder (OCD) is also associated with delayed sleep onset due to compulsive rituals. The review highlights the importance of differential diagnosis, as sleep complaints in anxious patients may mask other conditions such as nocturnal epilepsy or obstructive sleep apnea. A thorough clinical approach, including detailed sleep history, psychometric evaluations, and targeted investigations such as polysomnography or EEG when indicated, is essential to distinguish these conditions. Ultimately, the review reinforces that anxiety must be systematically evaluated and treated in patients presenting with sleep disorders, as addressing anxiety can significantly improve sleep and overall functioning. It calls for integrative, patient-centered care to navigate the complex interplay of psychiatric symptoms and sleep physiology.